scholarly journals Postgraduate training for family medicine in a rural district hospital in South Africa: Appropriateness and sufficiency of theatre procedures as a sentinel indicator

2016 ◽  
Vol 8 (1) ◽  
Author(s):  
Dawie Du Plessis ◽  
Paul Alfred Kapp ◽  
Louis S. Jenkins ◽  
Laurel Giddy
Keyword(s):  
Family Medicine ◽  
Rural Areas ◽  
Postgraduate Training ◽  
District Hospital ◽  
Learning Opportunities ◽  
Rural District ◽  
Procedural Skills ◽  
District Hospitals ◽  
National Unit ◽  
Unit Standards

Background: Since 2007, the postgraduate training of family physicians for South African district hospitals has been formalised. This training differs from European and North American programmes as up to 30% of the skills needed rely on district hospital surgical, obstetrics and anaesthetics procedures, particularly in rural areas, as outlined in the national unit standards. The aim of this study was to evaluate the appropriateness and sufficiency of learning opportunities for these skills in a rural district hospital.Methods: A descriptive, cross-sectional study was undertaken of the number and type of procedures performed in theatre for a 1-year period and compared with the required procedural skills stipulated in the national unit standards. Descriptive statistical analyses were used to analyse categorical data.Results: Three thousand seven hundred and forty-one procedures were performed during the study period. Anaesthesia was the most common procedure, followed by Caesarean section. There were adequate opportunities for teaching most core skills.Conclusions: Sufficient and appropriate learning opportunities exist for postgraduate family medicine training in all the core skills performed in a theatre according to the national unit standards.Keywords: Post Graduate Training, Family Medicine, Procedural Skills, Rural, District hospitals

Histopathology Services in a Rural African Hospital: How Audit Can Improve Service

1997 ◽  
Vol 27 (3) ◽  
pp. 131-132
Author(s):  
H Kettle ◽  
D Wilkinson
Keyword(s):  
Developing Countries ◽  
District Hospital ◽  
Rural District ◽  
Regional Laboratory ◽  
District Hospitals ◽  
Wide Range

Audit is about doing things right. We undertook a detailed audit of the histopathological service at a rural district hospital in Africa because delays in obtaining biopsy results had been noted by clinicians. A wide range of serious pathology was found in the 100 consecutive biopsies reviewed. It took 26 days on average from the time a biopsy was taken to the time the result was returned to the clinician, and most of this delay was administrative in nature, occurring after the pathologist had reviewed the specimen at the regional laboratory. Because of these delays, only 22% of patients biopsied were ever informed of their results. By performing this audit, reporting the results, and acting against the problems discovered, the service rapidly improved. This study illustrates the importance of simple, routine audit in district hospitals in developing countries.

scholarly journals Impact of Lean on patient cycle and waiting times at a rural district hospital in KwaZulu-Natal

2016 ◽  
Vol 8 (1) ◽  
Author(s):  
Logandran Naidoo ◽  
Ozayr H. Mahomed
Keyword(s):  
District Hospital ◽  
Waiting Times ◽  
Rural District ◽  
Management Approach ◽  
Lean Implementation ◽  
Cycle Times ◽  
Lean Principles ◽  
District Hospitals ◽  
Kwazulu Natal ◽  
The Impact

Background: Prolonged waiting time is a source of patient dissatisfaction with health care and is negatively associated with patient satisfaction. Prolonged waiting times in many district hospitals result in many dissatisfied patients, overworked and frustrated staff, and poor quality of care because of the perceived increased workload.Aim: The aim of the study was to determine the impact of Lean principles techniques, and tools on the operational efficiency in the outpatient department (OPD) of a rural district hospital.Setting: The study was conducted at the Catherine Booth Hospital (CBH) – a rural district hospital in KwaZulu-Natal, South Africa.Methods: This was an action research study with pre-, intermediate-, and post-implementation assessments. Cycle and waiting times were measured by direct observation on two occasions before, approximately two-weekly during, and on two occasions after Lean implementation. A standardised data collection tool was completed by the researcher at each of the six key service nodes in the OPD to capture the waiting times and cycle times.Results: All six service nodes showed a reduction in cycle times and waiting times between the baseline assessment and post-Lean implementation measurement. Significant reduction was achieved in cycle times (27%; p < 0.05) and waiting times (from 11.93 to 10 min; p = 0.03) at the Investigations node. Although the target reduction was not achieved for the Consulting Room node, there was a significant reduction in waiting times from 80.95 to 74.43 min, (p < 0.001). The average efficiency increased from 16.35% (baseline) to 20.13% (post-intervention).Conclusion: The application of Lean principles, tools and techniques provides hospital managers with an evidence-based management approach to resolving problems and improving quality indicators.

scholarly journals Students’ perceptions of the instructional quality of district hospital-based training

2016 ◽  
Vol 8 (1) ◽  
Author(s):  
Shehla Jabbar Memon ◽  
Jakobus Murray Louw ◽  
Martin Bac ◽  
Jannie Hugo ◽  
Waqar-un Nisa Rauf ◽  
...  
Keyword(s):  
Medical Education ◽  
Learning Environment ◽  
Student Satisfaction ◽  
Healthcare Workers ◽  
District Hospital ◽  
Instructional Quality ◽  
Learning Opportunities ◽  
Education Student ◽  
District Hospitals

Background: An innovative, three-year training programme, the Bachelor of Clinical Medical Practice (BCMP), for mid-level medical healthcare workers was started in 2009 by the Department of Family Medicine, University of Pretoria.Aim: To measure the students’ perceptions of the instructional quality of district hospitalbased training. Setting: Training of students took place at clinical learning centres in rural district hospitals in the Mpumalanga and Gauteng provinces.Methods: A survey using the MedEd IQ questionnaire was performed in 2010 and 2011 to measure BCMP second- and third-year students’ perceptions of instructional quality of district hospital-based training. The MedEd IQ questionnaire is composed of four subscales: preceptor activities, learning opportunities, learner involvement and the learning environment. Composite scores of instructional quality were used to present results.Results: The preceptor activities, learning opportunities and the learning environment were considered by second- and third-year BCMP students to be of consistently high instructional quality. In the area of learner involvement, instructional quality increased significantly from second to third year.Conclusion: Overall, instructional quality of district hospital-based training was high for both second- and third-year BCMP students, and the instructional quality of learner involvement being significantly higher in third year students. The MedEd IQ tool was a useful tool for measuring instructional quality and to inform programme quality improvement.Keywords: clinical associates, evaluation of medical education, mid-level healthcare workers, rural learning centres, rural medical education, student satisfaction.

scholarly journals Staffing rural hospitals through Umthombo Youth Development Foundation (UYDF) in South Africa: Challenges and Opportunities

2019 ◽  
Author(s):  
Ganzamungu Zihindula ◽  
Richard Gavin MacGregor ◽  
Andrew John Ross
Keyword(s):  
South Africa ◽  
Youth Development ◽  
Rural Areas ◽  
Descriptive Analysis ◽  
Case Study Research ◽  
Health Science ◽  
Rural District ◽  
Staffing Levels ◽  
District Hospitals ◽  
Challenges And Opportunities

Abstract Despite the governments ‘healthcare for all’ focus since the country’s first democratic election in 1994, many rural district hospitals in South Africa have struggled to find and retain adequate staffing levels in order to be able to deliver on the District hospital package of services. Many of these hospitals have relied on non-profit organisations and other privately owned institutions to assist them in improving their staffing levels and service delivery. Umthombo Youth Development Foundation (UYDF), a NPO’s started in 1999 at one rural hospital in the Province KwaZulu-Natal, provides funding to youth from rural areas to study a health science degrees with the understanding that they will return to serve at their rural-based hospitals. This review describes the role that UYDF has played in assisting rural-based hospitals with recruiting and retaining staff, the relationship between UYDF and hospitals, the ‘UYDF’ model, as well as the challenges and opportunities presented through the partnership between UYDF and rural district hospitals. It aims to inform and contribute to health policy initiatives that can help rural-based hospitals to recruit, attract and retain staff. Using a case study research design, existing data was used to present a detailed descriptive analysis of the UYDF health education and employment model. The results from this research paper suggest that the model provides a solution which can address the problem of hospital staffing, and that if challenges are managed, other rural-based hospitals in the country could benefit from the model.

scholarly journals Teaching procedural skills to family medicine residents: Preliminary report of the Bori experience.

2021 ◽  
Vol 6 (3) ◽  
pp. 087-096
Author(s):  
Paul O Dienye ◽  
Geraldine U Ndukwu ◽  
Alali I Dan-Jumbo ◽  
Biralo K. Paul
Keyword(s):  
Family Medicine ◽  
Cross Sectional Study ◽  
P Value ◽  
Procedural Skills ◽  
Common Procedure ◽  
Cross Sectional ◽  
Medicine Resident ◽  
District Hospitals ◽  
Significant Difference ◽  
The Right

Introduction: Proficiency in procedural skills is a prerequisite for graduating residents in Family Medicine. The acquisition of these skills required for clinical practice remains an ongoing challenge. In order to overcome the challenge of resident doctors in Family Medicine in acquiring competence in procedural skills, rural posting was added in their curriculum. Aim: The aim of this study was to evaluate the effect of dedicated teaching of procedural skills on the residents’ performance at the end of their rural posting. Method: A hospital based cross-sectional study in which respondents were recruited by convenient sample of all consenting residents (n = 29) from two training institutions who reported to the Bori Zonal Hospital for rural posting from 2018-2020. A questionnaire was administered to the respondents. A two sample t-test was used to compare the means and P-value of <0.05 was considered statistically significant. Result: A total of 728 procedures were performed during the period. The most common procedure performed was caesarean section and the least was repair of vesicovaginal fistula. The mean procedural rating score at the beginning and the end of the rural posting were 1.68±0.70 and 3.94±0.64 respectively. There was a significant difference between the procedure mean scores at the beginning and end of the rural posting (t=11.91, p< 0.0001, 95% confidence interval: -2.6414 to -1.8786). Conclusion: Given the right training in an enabling environment, the Family Medicine resident graduates proficient in the right mix of skills needed to run district Hospitals and other health institutions.

52. Simulation based training improves resident competence in the performance of critical resuscitation procedures

2007 ◽  
Vol 30 (4) ◽  
pp. 56
Author(s):  
I. Rigby ◽  
I. Walker ◽  
T. Donnon ◽  
D. Howes ◽  
J. Lord
Keyword(s):  
Internal Medicine ◽  
Emergency Medicine ◽  
Medical Education ◽  
Family Medicine ◽  
Training Program ◽  
Correlation Coefficient ◽  
Training Programs ◽  
Self Assessment ◽  
Procedural Skills ◽  
Simulation Based

We sought to assess the impact of procedural skills simulation training on residents’ competence in performing critical resuscitation skills. Our study was a prospective, cross-sectional study of residents from three residency training programs (Family Medicine, Emergency Medicine and Internal Medicine) at the University of Calgary. Participants completed a survey measuring competence in the performance of the procedural skills required to manage hemodynamic instability. The study intervention was an 8 hour simulation based training program focused on resuscitation procedure psychomotor skill acquisition. Competence was criterion validated at the Right Internal Jugular Central Venous Catheter Insertion station by an expert observer using a standardized checklist (Observed Structured Clinical Examination (OSCE) format). At the completion of the simulation course participants repeated the self-assessment survey. Descriptive Statistics, Cronbach’s alpha, Pearson’s correlation coefficient and Paired Sample t-test statistical tools were applied to the analyze the data. Thirty-five of 37 residents (9 FRCPC Emergency Medicine, 4 CCFP-Emergency Medicine, 17 CCFP, and 5 Internal Medicine) completed both survey instruments and the eight hour course. Seventy-two percent of participants were PGY-1 or 2. Mean age was 30.7 years of age. Cronbach’s alpha for the survey instrument was 0.944. Pearson’s Correlation Coefficient was 0.69 (p < 0.001) for relationship between Expert Assessment and Self-Assessment. The mean improvement in competence score pre- to post-intervention was 6.77 (p < 0.01, 95% CI 5.23-8.32). Residents from a variety of training programs (Internal Medicine, Emergency Medicine and Family Medicine) demonstrated a statistically significant improvement in competence with critical resuscitation procedural skills following an intensive simulation based training program. Self-assessment of competence was validated using correlation data based on expert assessments. Dawson S. Procedural simulation: a primer. J Vasc Interv Radiol. 2006; 17(2.1):205-13. Vozenilek J, Huff JS, Reznek M, Gordon JA. See one, do one, teach one: advanced technology in medical education. Acad Emerg Med. 2004; 11(11):1149-54. Ziv A, Wolpe PR, Small SD, Glick S. Simulation-based medical education: an ethical imperative. Acad Med. 2003; 78(8):783-8.

scholarly journals Investigating competencies needed by European-trained doctors in rural South African hospitals

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
James R. Barnacle ◽  
Oliver Johnson ◽  
Ian Couper
Keyword(s):  
South Africa ◽  
South African ◽  
Online Survey ◽  
Rural District ◽  
Eastern Cape ◽  
Rural Medicine ◽  
Rural South ◽  
District Hospitals ◽  
Kwazulu Natal ◽  
Postgraduate Diploma

Background: Many European-trained doctors (ETDs) recruited to work in rural district hospitals in South Africa have insufficient generalist competencies for the range of practice required. Africa Health Placements recruits ETDs to work in rural hospitals in Africa. Many of these doctors feel inadequately prepared. The Stellenbosch University Ukwanda Centre for Rural Health is launching a Postgraduate Diploma in Rural Medicine to help prepare doctors for such work.Aim: To determine the competencies gap for ETDs working in rural district hospitals in South Africa to inform the curriculum of the PG Dip (Rural Medicine).Setting: Rural district hospitals in South Africa.Methods: Nine hospitals in the Eastern Cape, KwaZulu-Natal and Mpumalanga were purposefully selected by Africa Health Placements as receiving ETDs. An online survey was developed asking about the most important competencies and weaknesses for ETDs when working rurally. The clinical manager and any ETDs currently working in each hospital were invited to complete the survey.Results: Surveys were completed by 19 ETDs and five clinical managers. The top clinical competencies in relation to 10 specific domains were identified. The results also indicate broader competencies required, specific skills gaps, the strengths that ETDs bring to South Africa and how ETDs prepare themselves for working in this context.Conclusion: This study identifies the important competency gaps among ETDs and provides useful direction for the diploma and other future training initiatives. The diploma faculty must reflect on these findings and ensure the curriculum is aligned with these gaps.

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